| Values |
| Female |
| Male |
| prefer not to disclose |
| X |
| Field Name | Data Type | Value |
| Program | Dropdown | Nursing Assistant |
| Professions | Dropdown | Nursing Assistant |
| Nursing Assistant Certification | Checkbox | True |
| Field Name | Data Type | Value |
| Alternate Names: | Text | Auto |
| Field Name | Data Type | Value |
| 1a. Please explain medical condition. | Textarea | Test Medical Condition |
| 1b. Please explain how your treatment has reduced or eliminated the limitations caused by your medical condition. | Textarea | Test Limitations |
| 1c. Please explain how your field of practice, the setting or manner of practice has reduced or eliminated the limitations caused by your medical condition. | Textarea | Test limitations caused by your medical condition |
| Field Name | Data Type | Value |
| 2a. Chemical Substance Explanation | Textarea | Test Chemical Substance |
| Field Name | Data Type | Value |
| 3a. Diagnosis Explanation | Textarea | Test Diagnosis Explanation |
| Field Name | Data Type | Value |
| 4a. Controlled Substances Explanation | Textarea | Test illegal issue |
| Field Name | Data Type | Value |
| 5a. Conviction Explanation | Textarea | Test Conviction Explanation |
| Field Name | Data Type | Value |
| 6a. Controlled Substance Legal Explanation | Textarea | Test Controlled Substances Explanation |
| Field Name | Data Type | Value |
| 6b. Criminal Proceedings Explanation | Textarea | Test Criminal Proceedings |
| Field Name | Data Type | Value |
| 6c. Drug Law Violations Explanation | Textarea | Test Drug Law |
| Field Name | Data Type | Value |
| 6d. Self Prescribed Controlled Substance Explanation | Textarea | Test Self Prescribed |
| Field Name | Data Type | Value |
| 7a. Violation of State or Federal Law Explanation | Textarea | Test Violation of state |
| Field Name | Data Type | Value |
| 8a. License, Certificate, Registration Issue Explanation | Textarea | Test License Certificate |
| Field Name | Data Type | Value |
| 9a. Surrender Explanation | Textarea | Test surreender explanation |
| Field Name | Data Type | Value |
| 10a. Civil Judgement Explanation | Textarea | Test Civil Judgement |
| Field Name | Data Type | Value |
| 11a. Vulnerable Persons Disqualification Explanation | Textarea | Test Vulnerable persons |
| Field Name | Data Type | Value |
| 1. Enter your National Provider Identifier (NPI) Number if available. | Text | 1234567890 |
| Field Name | Data Type | Value |
| How did you receive this credential? | Dropdown | Grandparented |
| Country | Dropdown | United States |
| State or Province | Dropdown | Alabama |
| Profession | Text | Test Doctor |
| Credential Type | Dropdown | Temporary |
| Credential Number | Text | 12345678 |
| Issue Date | Date | Today - 100 |
| Expiration Date | Date | Today - 0 |
| Field Name | Data Type | Value |
| I am a medical assistant certified as defined in WAC 246-841-535. | Radiobutton | true |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| State or Province | Dropdown | Alabama |
| City | Text | Test |
| Approved Training Program Name | Text | Test Approved Training Program Name |
| Date From | Date | Today - 300 |
| Date To | Date | Today - 0 |
| Attendance Status | Dropdown | Graduated |
| Graduation Date or Program Completion Date if Applicable | Date | Today - 10 |
| Field Name | Data Type | Value |
| Date of Written/Oral Examination | Text | 10-22-2022 |
| Date of Skills Examination | Text | 12-22-2022 |
| Field Name | Data Type | Value |
| I agree. | Checkbox | true |
| Field Name |
| First Name |
| Last Name |
| Date of Birth (mm/dd/yyyy) |
| Social Security Number |
| Gender |
| Street |
| City |
| Country |
| State |
| Zip Code |
| County |
| Phone Number |
| Cell Number |
| Email Address |
| Expiration Date |
| Issue Date |
| Field Name |
| First Name |
| Last Name |
| Date of Birth (mm/dd/yyyy) |
| Social Security Number |
| Gender |
| Street |
| City |
| Country |
| State |
| Zip Code |
| County |
| Phone Number |
| Cell Number |
| Email Address |
| 1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety? |
| 1a. Please explain medical condition. |
| 1b. Please explain how your treatment has reduced or eliminated the limitations caused by your medical condition. |
| 1c. Please explain how your field of practice, the setting or manner of practice has reduced or eliminated the limitations caused by your medical condition. |
| 2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety? |
| 2a. Chemical Substance Explanation |
| 3. Have you ever been diagnosed with, or treated for, pedophilia, exhibitionism, voyeurism or frotteurism? |
| 3a. Diagnosis Explanation |
| 4. Are you currently engaged in the illegal use of controlled substances? |
| 4a. Controlled Substances Explanation |
| 5. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction? |
| 5a. Conviction Explanation |
| 6a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes? |
| 6a. Controlled Substance Legal Explanation |
| 6b. Diverted controlled substances or legend drugs? |
| 6b. Criminal Proceedings Explanation |
| 6c. Violated any drug law? |
| 6d. Prescribed controlled substances for yourself? |
| 6d. Self Prescribed Controlled Substance Explanation |
| 7. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession? |
| 7a. Violation of State or Federal Law Explanation |
| 8. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority? |
| 8a. License, Certificate, Registration Issue Explanation |
| 9. Have you ever surrendered a credential like those listed in number 8, in connection with or to avoid action by a state, federal, or foreign authority? |
| 9a. Surrender Explanation |
| 10. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession? |
| 10a. Civil Judgement Explanation |
| 11. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)? |
| 11a. Vulnerable Persons Disqualification Explanation |
| 1. Enter your National Provider Identifier (NPI) Number if available. |
| Are you the spouse or registered domestic partner of military personnel? |
| State or Province |
| Profession |
| Credential Type |
| Credential Number |
| Issue Date |
| Expiration Date |
| Is this credential currently in an active status? |
| Field Name | Data Type | Value |
| Expiration Date | Date | Today + 30 |
| Field Name | Value |
| Status | Active |
| Text |
| The Washington State Department of Health needs your help! We’re implementing a survey of healthcare providers to improve our understanding of Washington’s healthcare workforce, helping us answer questions such as, “Are providers working? Where are they working? What’s their area of specialty?” The results will help promote your profession and aid our knowledge of the healthcare workforce. |
| We recognize you’re busy, so we’ve made the survey as short as possible. Most questions are yes-no or multiple-choice answers. We estimate that this will take you approximately 10 minutes to complete. While it’s voluntary, we hope you’ll participate. |
| Please take the Washington Health Workforce Survey. |
| Field Name | Values |
| Dated: | Today - 0 |
| Initials: | AT |
| Field Name | Data Type | Value |
| I agree. | Checkbox | true |
| Text |
| There is a $2.50 convenience fee required to use the online service when paying by credit card/debit card. The amount will be charged in addition to your fee(s). There is no additional convenience fee for ACH payments. |
| Fees submitted with applications for initial credentialing, examinations, renewal and other fees associated with the licensing and regulation of the profession are nonrefundable. |
| Link |
| WAC 246-12-340. |
| Field Name | Data Type | Value |
| Expiration Date | Date | Today - 30 |
| Field Name | Value |
| Status | Expired |
| Sub Status | Eligible for Late Renewal |
| Text |
| The Washington State Department of Health needs your help! We’re implementing a survey of healthcare providers to improve our understanding of Washington’s healthcare workforce, helping us answer questions such as, “Are providers working? Where are they working? What’s their area of specialty?” The results will help promote your profession and aid our knowledge of the healthcare workforce. |
| We recognize you’re busy, so we’ve made the survey as short as possible. Most questions are yes-no or multiple-choice answers. We estimate that this will take you approximately 10 minutes to complete. While it’s voluntary, we hope you’ll participate. |
| Please take the Washington Health Workforce Survey. |
| Field Name | Values |
| Dated: | Today - 0 |
| Initials: | AT |
| Field Name | Data Type | Value |
| I agree. | Checkbox | true |
| Text |
| There is a $2.50 convenience fee required to use the online service when paying by credit card/debit card. The amount will be charged in addition to your fee(s). There is no additional convenience fee for ACH payments. |
| Fees submitted with applications for initial credentialing, examinations, renewal and other fees associated with the licensing and regulation of the profession are nonrefundable. |
| Link |
| WAC 246-12-340. |
| Timestamp | TestName | Status |
|---|---|---|
| Nov 3, 2022 02:25:14 PM | Validating the Intake Flow of Nursing Assistant Certification License.1.Validate that the HELMS portal happy path flow of Nursing Assistant Certification Intake flow | pass |
| Name | Value |
|---|---|
| User Name | prince.gupta_mtxb2b |
| Time Zone | Asia/Calcutta |
| Machine | Windows 10 - 64 Bit |
| Selenium | 3.7.0 |
| Maven | 3.6.3 |
| Java Version | 1.8.0_151 |
| Name | Passed | Failed | Others | Passed % |
|---|---|---|---|---|
| @NursingAssistantCertificationFlow1 | 1 | 0 | 0 | 100% |